Wikström Lotta, Eriksson Kerstin, Fridlund Bengt, Nilsson Mats, Årestedt Kristofer, Broström Anders
School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden.
J Clin Nurs. 2017 Dec;26(23-24):4675-4684. doi: 10.1111/jocn.13818. Epub 2017 May 18.
(i) To determine whether a central tendency, median, based on patients' self-rated pain is a clinically applicable daily measure to show patients' postoperative pain on the first day after major surgery (ii) and to determine the number of self-ratings required for the calculation of this measure.
Perioperative pain traits in medical records are difficult to overview. The clinical applicability of a daily documented summarising measure of patients' self-rated pain scores is little explored.
A repeated measure design was carried out at three Swedish country hospitals.
Associations between the measures were analysed with nonparametric statistical methods; systematic and individual group changes were analysed separately. Measure I: pain scores at rest and activity postoperative day 1; measure II: retrospective average pain from postoperative day 1.
The sample consisted of 190 general surgery patients and 289 orthopaedic surgery patients with a mean age of 65; 56% were men. Forty-four percent had a pre-operative daily intake of analgesia, and 77% used postoperative opioids. A range of 4-9 pain scores seem to be eligible for the calculation of the daily measures of pain. Rank correlations for individual median scores, based on four ratings, vs. retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. A systematic group change towards a higher level of reported retrospective pain was significant.
The median values were clinically applicable daily measures. The risk of obtaining a higher value than was recalled by patients seemed to be low. Applicability increased with increased frequency of self-rated pain scores and with high-quality pain assessments.
The documenting of daily median pain scores at rest and during activity could constitute the basis for obtaining patients' experiences by showing their pain severity trajectories. The measures could also be an important key to predicting postoperative health-related consequences.
（i）确定基于患者自评疼痛的集中趋势中位数是否为一种临床适用的日常测量方法，以显示患者在大手术后第一天的术后疼痛情况；（ii）确定计算该测量值所需的自评次数。
病历中的围手术期疼痛特征难以概述。对于每日记录的患者自评疼痛评分汇总测量方法的临床适用性研究较少。
在瑞典的三家乡村医院进行了重复测量设计。
采用非参数统计方法分析测量值之间的关联；分别分析系统和个体组的变化。测量一：术后第1天休息和活动时的疼痛评分；测量二：术后第1天的回顾性平均疼痛。
样本包括190例普通外科患者和289例骨科手术患者，平均年龄65岁；56%为男性。44%的患者术前每日服用镇痛药，77%的患者术后使用阿片类药物。4 - 9分的疼痛评分范围似乎适合用于计算每日疼痛测量值。基于四次评分的个体中位数评分与回顾性自评平均疼痛之间的等级相关性中等，且随着评分次数的增加而增强。报告的回顾性疼痛水平系统性地向更高水平变化具有显著性。
中位数是临床适用的日常测量方法。获得高于患者回忆值的风险似乎较低。随着自评疼痛评分频率的增加和高质量疼痛评估的进行，适用性增强。
记录休息和活动时的每日疼痛中位数评分可为了解患者的疼痛严重程度轨迹提供依据，从而获取患者的体验。这些测量方法也可能是预测术后与健康相关后果的重要关键。
